<#assign title="用户满意度有奖调查答卷列表添加页面">
<#include "/admin/inc/top.html"/>
<div class="main-content" id="main-content">
    <header class="header navbar bg-white shadow">
        <div class="btn-group tool-button">
            <a class="btn btn-primary navbar-btn" href="${base!}/private/picc/satisfyQuestion" data-pjax><i
                    class="fa fa-reply"></i> 返回</a>
        </div>
    </header>
    <section class="content">

        <div class="form-wrapper" style="min-height:500px;">
            <section class="panel panel-form">
                <form id="unitAddForm" role="form" class="form-horizontal parsley-form" data-parsley-validate
                      action="${base!}/private/picc/satisfyQuestion/addDo" method="post">
                    <div class="row mb10">
                        <div class="col-lg-12">
                            <div class="form-group">
                                <label for="openId" class="col-sm-2 control-label">微信openId</label>

                                <div class="col-sm-8">
                                    <input type="text" id="openId" class="form-control" name="openId"
                                      placeholder="微信openId">
                                </div>
                            </div>
                            <div class="hr-line-dashed"></div>
                            <div class="form-group">
                                <label for="pid" class="col-sm-2 control-label">人保ID</label>

                                <div class="col-sm-8">
                                    <input type="text" id="pid" class="form-control" name="pid"
                                      placeholder="人保ID">
                                </div>
                            </div>
                            <div class="hr-line-dashed"></div>
                            <div class="form-group">
                                <label for="userName" class="col-sm-2 control-label">投保人姓名</label>

                                <div class="col-sm-8">
                                    <input type="text" id="userName" class="form-control" name="userName"
                                      placeholder="投保人姓名">
                                </div>
                            </div>
                            <div class="hr-line-dashed"></div>
                            <div class="form-group">
                                <label for="phoneNum" class="col-sm-2 control-label">投保人手机号</label>

                                <div class="col-sm-8">
                                    <input type="text" id="phoneNum" class="form-control" name="phoneNum"
                                      placeholder="投保人手机号">
                                </div>
                            </div>
                            <div class="hr-line-dashed"></div>
                            <div class="form-group">
                                <label for="hasPolicy" class="col-sm-2 control-label">是否拥有我公司保单 0：没有 1：有</label>

                                <div class="col-sm-8">
                                    <input type="text" id="hasPolicy" class="form-control" name="hasPolicy"
                                     data-parsley-type="number" placeholder="是否拥有我公司保单 0：没有 1：有">
                                </div>
                            </div>
                            <div class="hr-line-dashed"></div>
                            <div class="form-group">
                                <label for="latestServiceTime" class="col-sm-2 control-label">最近一次接受我公司服务时间</label>

                                <div class="col-sm-8">
                                    <input type="text" id="latestServiceTime" class="form-control" name="latestServiceTime"
                                      placeholder="最近一次接受我公司服务时间">
                                </div>
                            </div>
                            <div class="hr-line-dashed"></div>
                            <div class="form-group">
                                <label for="serviceCompany" class="col-sm-2 control-label">服务机构分公司</label>

                                <div class="col-sm-8">
                                    <input type="text" id="serviceCompany" class="form-control" name="serviceCompany"
                                      placeholder="服务机构分公司">
                                </div>
                            </div>
                            <div class="hr-line-dashed"></div>
                            <div class="form-group">
                                <label for="serviceAgent" class="col-sm-2 control-label">该次服务办理机构</label>

                                <div class="col-sm-8">
                                    <input type="text" id="serviceAgent" class="form-control" name="serviceAgent"
                                      placeholder="该次服务办理机构">
                                </div>
                            </div>
                            <div class="hr-line-dashed"></div>
                            <div class="form-group">
                                <label for="serviceDetail" class="col-sm-2 control-label">服务内容</label>

                                <div class="col-sm-8">
                                    <input type="text" id="serviceDetail" class="form-control" name="serviceDetail"
                                      placeholder="服务内容">
                                </div>
                            </div>
                            <div class="hr-line-dashed"></div>
                            <div class="form-group">
                                <label for="isSatisfied" class="col-sm-2 control-label">服务是否满意</label>

                                <div class="col-sm-8">
                                    <input type="text" id="isSatisfied" class="form-control" name="isSatisfied"
                                      placeholder="服务是否满意">
                                </div>
                            </div>
                            <div class="hr-line-dashed"></div>
                            <div class="form-group">
                                <label for="notSatisfyReason" class="col-sm-2 control-label">不满意的原因</label>

                                <div class="col-sm-8">
                                    <input type="text" id="notSatisfyReason" class="form-control" name="notSatisfyReason"
                                      placeholder="不满意的原因">
                                </div>
                            </div>
                            <div class="hr-line-dashed"></div>
                            <div class="form-group">
                                <label for="rec2Friend" class="col-sm-2 control-label">否愿意将我司产品推荐给朋友</label>

                                <div class="col-sm-8">
                                    <input type="text" id="rec2Friend" class="form-control" name="rec2Friend"
                                      placeholder="否愿意将我司产品推荐给朋友">
                                </div>
                            </div>
                            <div class="hr-line-dashed"></div>
                            <div class="form-group">
                                <label for="scoreReason" class="col-sm-2 control-label">导致您给予我司分值的原因</label>

                                <div class="col-sm-8">
                                    <input type="text" id="scoreReason" class="form-control" name="scoreReason"
                                      placeholder="导致您给予我司分值的原因">
                                </div>
                            </div>
                            <div class="hr-line-dashed"></div>
                            <div class="form-group">
                                <label for="fromChannel" class="col-sm-2 control-label">您是从哪个渠道了解到我公司的</label>

                                <div class="col-sm-8">
                                    <input type="text" id="fromChannel" class="form-control" name="fromChannel"
                                      placeholder="您是从哪个渠道了解到我公司的">
                                </div>
                            </div>
                            <div class="hr-line-dashed"></div>
                            <div class="form-group">
                                <label for="doPrizeStatus" class="col-sm-2 control-label">投保人是否有抽奖资格</label>

                                <div class="col-sm-8">
                                    <input type="text" id="doPrizeStatus" class="form-control" name="doPrizeStatus"
                                     data-parsley-type="number" placeholder="投保人是否有抽奖资格">
                                </div>
                            </div>
                            <div class="hr-line-dashed"></div>
                        </div>
                    </div>
                    <div class="col-lg-3"></div>
                    <div class="col-lg-6">
                        <div class="form-group text-center">
                            <label></label>

                            <div>
                                <button class="btn btn-primary btn-block btn-lg btn-parsley"
                                        data-loading-text="正在提交...">提 交
                                </button>
                            </div>
                        </div>
                    </div>
                </form>
            </section>

        </div>
        <a class="exit-offscreen"></a>
    </section>
</div>
<script language="JavaScript">
    $(document).ready(function () {
        $('#unitAddForm').ajaxForm({
            dataType: 'json',
            beforeSubmit: function (arr, form, options) {
                form.find("button:submit").button("loading");
            },
            success: function (data, statusText, xhr, form) {
                if (data.code == 200) {
                    Toast.success(data.msg);
                    form.resetForm();
                } else {
                    Toast.error(data.msg);
                }
                form.find("button:submit").button("reset");
            }
        });
    });
</script>
<#include "/admin/inc/bottom.html"/>